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Thoracic epidural analgesia in anaesthesia for liver transplantation: The 10-year experience of a single centre

Janusz Trzebicki, Barbara Nicinska, Beata Blaszczyk, Lidia Jureczko, Marcin Kolacz, Marek Pacholczyk, Andrzej Chmura, Beata Lagiewska, Leszek Adadynski, Piotr Malkowski, Dariusz Wasiak, Wojciech Lisik, Artur Kwiatkowski, Tomasz Lazowski

Ann Transplant 2010; 15(2): 35-39

ID: 880938

Published: 2010-06-28

Background:    Improvements in operating techniques, methods of anaesthesia and postoperative care in liver transplantation (LT) contribute to better outcomes. In order to restrict postoperative mechanical ventilation, a thoracic epidural analgesia (TEA) has been performed in our centre since 2000. In this report we present our 10-year experience of using TEA as a component of LT anaesthesia.
    Material/Methods:    TEA was performed, by anaesthetists experienced in this method, on patients qualified for LT, who consented and met inclusion criteria: INR<1.5, APTT<45s and platelets >70 G/L. Since 2008 the decision to insert an epidural catheter has been additionally supported by thromboelastometry. We assessed extubation time, frequency of complications of TEA and undesired accidents.
    Results:    From 279 patients undergoing LT, TEA was performed on 67 (24%), and from these 56 (84%) were extubated in the operating theatre. There were 5 cases of unsatisfactory thoracic epidural analgesia. Only 1 epidural catheter was removed accidentally, on the 2nd postoperative day. None of the complications of TEA were observed in the TEA group.
    Conclusions:    Based on our observations, it can be assumed that TEA done by experienced an anaesthetist is a safe component of anaesthesia in selected groups of patients undergoing LT, and allows for early extubation.

Keywords: Liver Transplantation, thoracic epidural analgesia, anaesthesia